Provider First Line Business Practice Location Address:
1500 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
#314
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-244-5117
Provider Business Practice Location Address Fax Number:
818-244-6957
Provider Enumeration Date:
01/12/2007