Provider First Line Business Practice Location Address:
1183 E ANAHEIM STREET
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:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-912-4367
Provider Business Practice Location Address Fax Number:
562-912-4369
Provider Enumeration Date:
01/04/2007