Provider First Line Business Practice Location Address:
2345 EAST 4TH STREET
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:
90814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-847-7606
Provider Business Practice Location Address Fax Number:
310-847-7610
Provider Enumeration Date:
03/12/2012