Provider First Line Business Practice Location Address:
2317 E ANAHEIM 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:
90804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-621-0838
Provider Business Practice Location Address Fax Number:
562-621-9020
Provider Enumeration Date:
12/13/2005