Provider First Line Business Practice Location Address:
1341 E COLORADO ST
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:
91205-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-265-5088
Provider Business Practice Location Address Fax Number:
818-553-1075
Provider Enumeration Date:
04/27/2006