Provider First Line Business Practice Location Address:
214 N CENTRAL AVE
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:
91203-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-246-8000
Provider Business Practice Location Address Fax Number:
818-696-2176
Provider Enumeration Date:
09/14/2012