Provider First Line Business Practice Location Address:
1516 E SOUTH ST
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:
90805-4341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-472-0479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2008