Provider First Line Business Practice Location Address:
319 REDONDO 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:
90814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-423-7878
Provider Business Practice Location Address Fax Number:
562-438-7393
Provider Enumeration Date:
04/18/2007