Provider First Line Business Practice Location Address:
610 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-1276
Provider Business Practice Location Address Fax Number:
818-242-0726
Provider Enumeration Date:
07/28/2006