Provider First Line Business Practice Location Address:
5658 E DEBORAH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-425-3242
Provider Business Practice Location Address Fax Number:
562-596-8901
Provider Enumeration Date:
05/29/2007