Provider First Line Business Practice Location Address:
3742 LOCUST 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:
90807-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-342-0100
Provider Business Practice Location Address Fax Number:
213-342-0200
Provider Enumeration Date:
09/16/2009