Provider First Line Business Practice Location Address:
5808 E NAPLES PLZ
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:
90803-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-856-9294
Provider Business Practice Location Address Fax Number:
562-684-4441
Provider Enumeration Date:
02/17/2009