Provider First Line Business Practice Location Address:
3530 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-6938
Provider Business Practice Location Address Fax Number:
562-595-7152
Provider Enumeration Date:
12/05/2006