Provider First Line Business Practice Location Address:
403 S GLENDALE AVE
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:
91205-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-546-1929
Provider Business Practice Location Address Fax Number:
818-546-1930
Provider Enumeration Date:
04/11/2007