Provider First Line Business Practice Location Address:
1330 E SOUTH ST
Provider Second Line Business Practice Location Address:
UNIT 5
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-422-3999
Provider Business Practice Location Address Fax Number:
562-422-3988
Provider Enumeration Date:
09/20/2006