Provider First Line Business Practice Location Address:
1248 S GLENDALE BLVD
Provider Second Line Business Practice Location Address:
Y
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-247-0066
Provider Business Practice Location Address Fax Number:
818-247-0011
Provider Enumeration Date:
11/09/2006