Provider First Line Business Practice Location Address:
1500 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 318
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:
818-548-5437
Provider Business Practice Location Address Fax Number:
818-548-5445
Provider Enumeration Date:
09/16/2006