Provider First Line Business Practice Location Address:
3840 WOODRUFF AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-421-3751
Provider Business Practice Location Address Fax Number:
562-497-1131
Provider Enumeration Date:
04/18/2007