Provider First Line Business Practice Location Address:
1146 N. CENTRAL AVENUE, #522
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-500-0910
Provider Business Practice Location Address Fax Number:
818-500-0914
Provider Enumeration Date:
09/02/2006