Provider First Line Business Practice Location Address:
428 ARDEN AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-8131
Provider Business Practice Location Address Fax Number:
818-243-9972
Provider Enumeration Date:
06/08/2005