Provider First Line Business Practice Location Address:
1040 ELM AVE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-491-2145
Provider Business Practice Location Address Fax Number:
562-799-3721
Provider Enumeration Date:
01/12/2007