Provider First Line Business Practice Location Address:
501 E HARVARD ST UNIT A
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:
91205-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-551-0026
Provider Business Practice Location Address Fax Number:
818-551-0027
Provider Enumeration Date:
04/15/2013