Provider First Line Business Practice Location Address:
624 S. CENTRAL 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:
91204-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-3369
Provider Business Practice Location Address Fax Number:
818-242-0640
Provider Enumeration Date:
10/05/2006