Provider First Line Business Practice Location Address:
4342 ATLANTIC AVENUE SUITE B
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:
90807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-2114
Provider Business Practice Location Address Fax Number:
565-424-2116
Provider Enumeration Date:
09/04/2009