Provider First Line Business Practice Location Address:
2338 E ANAHEIM ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-5730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-438-3324
Provider Business Practice Location Address Fax Number:
562-987-1801
Provider Enumeration Date:
11/08/2006