Provider First Line Business Practice Location Address:
2650 ELM AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-427-5409
Provider Business Practice Location Address Fax Number:
562-426-6321
Provider Enumeration Date:
10/11/2006