Provider First Line Business Practice Location Address:
139 S VERDUGO RD
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-4061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-549-0889
Provider Business Practice Location Address Fax Number:
818-549-0557
Provider Enumeration Date:
08/25/2006