Provider First Line Business Practice Location Address:
1300 S. 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:
91204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-245-8410
Provider Business Practice Location Address Fax Number:
818-245-8412
Provider Enumeration Date:
10/22/2010