Provider First Line Business Practice Location Address:
5963 E SPRING ST
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:
90808-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-421-8401
Provider Business Practice Location Address Fax Number:
562-421-0523
Provider Enumeration Date:
12/12/2006