Provider First Line Business Practice Location Address:
318 1/2 N BRAND BLVD
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:
91203-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-246-1956
Provider Business Practice Location Address Fax Number:
818-246-0161
Provider Enumeration Date:
05/23/2006