Provider First Line Business Practice Location Address:
3720 E ANAHEIM ST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-4085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-986-2865
Provider Business Practice Location Address Fax Number:
562-684-4400
Provider Enumeration Date:
10/21/2005