Provider First Line Business Practice Location Address:
5509 E SPRING 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:
90808-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-421-8206
Provider Business Practice Location Address Fax Number:
562-497-1885
Provider Enumeration Date:
10/08/2006