Provider First Line Business Practice Location Address:
4342 ATLANTIC AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-981-1437
Provider Business Practice Location Address Fax Number:
562-981-1438
Provider Enumeration Date:
03/22/2007