Provider First Line Business Practice Location Address:
1217 S 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:
91204-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-9595
Provider Business Practice Location Address Fax Number:
818-242-9524
Provider Enumeration Date:
04/06/2006