Provider First Line Business Practice Location Address:
5305 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90803-5340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-230-8093
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007