Provider First Line Business Practice Location Address:
6060 N PARAMOUNT BLVD
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:
90805-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-630-8672
Provider Business Practice Location Address Fax Number:
562-529-2463
Provider Enumeration Date:
01/02/2007