Provider First Line Business Practice Location Address:
273 E SOUTH ST
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:
90805-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-728-9600
Provider Business Practice Location Address Fax Number:
562-422-9011
Provider Enumeration Date:
04/30/2008