Provider First Line Business Practice Location Address:
532 E 29TH 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:
90806-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-3125
Provider Business Practice Location Address Fax Number:
562-427-5027
Provider Enumeration Date:
06/16/2008