Provider First Line Business Practice Location Address:
1241 S GLENDALE AVE
Provider Second Line Business Practice Location Address:
SUITE 205A
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-760-1110
Provider Business Practice Location Address Fax Number:
818-760-1177
Provider Enumeration Date:
02/02/2011