Provider First Line Business Practice Location Address:
1339 HIGHLAND 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:
91202-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-240-9191
Provider Business Practice Location Address Fax Number:
818-484-4000
Provider Enumeration Date:
11/26/2024