Provider First Line Business Practice Location Address:
3469 N VERDUGO RD
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:
91208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-249-6636
Provider Business Practice Location Address Fax Number:
818-249-5074
Provider Enumeration Date:
09/21/2006