Provider First Line Business Practice Location Address:
1640 SANTA BARBARA 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:
91208-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-846-8793
Provider Business Practice Location Address Fax Number:
818-506-7674
Provider Enumeration Date:
03/13/2007