Provider First Line Business Practice Location Address:
1516 E SOUTH 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:
90805-4341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-428-6693
Provider Business Practice Location Address Fax Number:
562-422-5321
Provider Enumeration Date:
10/12/2006