Provider First Line Business Practice Location Address:
214 N CENTRAL 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:
91203-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-0970
Provider Business Practice Location Address Fax Number:
818-638-0024
Provider Enumeration Date:
03/27/2006