Provider First Line Business Practice Location Address:
1500 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 326
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-956-8582
Provider Business Practice Location Address Fax Number:
818-956-0329
Provider Enumeration Date:
06/16/2007