Provider First Line Business Practice Location Address:
1259 S GLENDALE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-3298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-500-9469
Provider Business Practice Location Address Fax Number:
818-500-9119
Provider Enumeration Date:
09/13/2006