Provider First Line Business Practice Location Address:
1533 ALAMITOS 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:
90813-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-599-2119
Provider Business Practice Location Address Fax Number:
562-599-7454
Provider Enumeration Date:
03/19/2007