Provider First Line Business Practice Location Address:
8427 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-2486
Provider Business Practice Location Address Fax Number:
562-943-7518
Provider Enumeration Date:
02/04/2008