Provider First Line Business Practice Location Address:
7890 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:
90815-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-596-8753
Provider Business Practice Location Address Fax Number:
707-897-1657
Provider Enumeration Date:
10/28/2005