Provider First Line Business Practice Location Address:
6470 N PARAMOUNT 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:
90805-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-422-2389
Provider Business Practice Location Address Fax Number:
310-320-1924
Provider Enumeration Date:
05/21/2008