Provider First Line Business Practice Location Address:
6500 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
JORDAN HS LBUSD
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-423-1471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007