Provider First Line Business Practice Location Address:
3318 E ANAHEIM 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:
90804-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-986-5570
Provider Business Practice Location Address Fax Number:
562-986-9791
Provider Enumeration Date:
07/17/2008