Provider First Line Business Practice Location Address:
1133 S CENTRAL AVE UNIT 1
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:
91204-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-244-0400
Provider Business Practice Location Address Fax Number:
818-244-2836
Provider Enumeration Date:
07/15/2005