Provider First Line Business Practice Location Address:
239 S VERDUGO RD
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:
91205-1458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-543-7605
Provider Business Practice Location Address Fax Number:
818-291-8646
Provider Enumeration Date:
01/09/2008