Provider First Line Business Practice Location Address:
540 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-500-0205
Provider Business Practice Location Address Fax Number:
818-500-1348
Provider Enumeration Date:
09/07/2006