Provider First Line Business Practice Location Address:
330 N CENTRAL AVENUE
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:
91203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-2990
Provider Business Practice Location Address Fax Number:
818-242-3763
Provider Enumeration Date:
10/03/2006