Provider First Line Business Practice Location Address:
2315 E ANAHEIM 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:
90804-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-621-9211
Provider Business Practice Location Address Fax Number:
562-621-9020
Provider Enumeration Date:
03/12/2007