Provider First Line Business Practice Location Address:
220 S KENWOOD ST.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-4948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-376-8661
Provider Business Practice Location Address Fax Number:
818-376-8662
Provider Enumeration Date:
04/17/2014