Provider First Line Business Practice Location Address:
315 ARDEN AVE STE 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-330-5599
Provider Business Practice Location Address Fax Number:
818-500-8099
Provider Enumeration Date:
10/26/2020