Provider First Line Business Practice Location Address:
4918 E 2ND 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:
90803-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-438-1176
Provider Business Practice Location Address Fax Number:
562-438-8470
Provider Enumeration Date:
05/08/2007