Provider First Line Business Practice Location Address:
644 ARDEN 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:
91202-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-314-0101
Provider Business Practice Location Address Fax Number:
818-338-9218
Provider Enumeration Date:
06/06/2007