Provider First Line Business Practice Location Address:
1760 TERMINO
Provider Second Line Business Practice Location Address:
#223 CHISATO OBA MD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-344-1280
Provider Business Practice Location Address Fax Number:
562-344-1285
Provider Enumeration Date:
06/19/2009