Provider First Line Business Practice Location Address:
2699 ATLANTIC AVE
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:
90806-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-492-5950
Provider Business Practice Location Address Fax Number:
562-424-1174
Provider Enumeration Date:
05/02/2006