Provider First Line Business Practice Location Address:
403 S LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-774-6551
Provider Business Practice Location Address Fax Number:
310-763-2315
Provider Enumeration Date:
02/08/2007