Provider First Line Business Practice Location Address:
5000 E SPRING ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-596-5196
Provider Business Practice Location Address Fax Number:
562-252-9505
Provider Enumeration Date:
06/13/2006