Provider First Line Business Practice Location Address:
720 ALAMITOS AVE
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:
90813-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-218-6284
Provider Business Practice Location Address Fax Number:
562-489-0175
Provider Enumeration Date:
08/24/2010