Provider First Line Business Practice Location Address:
1222 S GLENDALE AVE UNIT 2
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:
91205-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-547-1055
Provider Business Practice Location Address Fax Number:
818-547-2631
Provider Enumeration Date:
07/24/2007