Provider First Line Business Practice Location Address:
1500 SOUTH CENTRAL AVENUE #100
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-367-7980
Provider Business Practice Location Address Fax Number:
818-637-7985
Provider Enumeration Date:
04/10/2006