Provider First Line Business Practice Location Address:
207 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:
91203-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-243-8888
Provider Business Practice Location Address Fax Number:
818-243-8808
Provider Enumeration Date:
12/12/2006