Provider First Line Business Practice Location Address:
3311 GLENDALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90039-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-665-7665
Provider Business Practice Location Address Fax Number:
323-953-6695
Provider Enumeration Date:
03/25/2008