Provider First Line Business Practice Location Address:
1415 E COLORADO ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-545-9800
Provider Business Practice Location Address Fax Number:
818-545-3800
Provider Enumeration Date:
04/16/2012