Provider First Line Business Practice Location Address:
1718 E ARTESIA BLVD
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:
90805-1649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-423-2175
Provider Business Practice Location Address Fax Number:
562-984-2542
Provider Enumeration Date:
12/01/2006