Provider First Line Business Practice Location Address:
623 S. LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE A/B
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-637-0341
Provider Business Practice Location Address Fax Number:
310-637-0341
Provider Enumeration Date:
09/14/2009