Provider First Line Business Practice Location Address:
1441 W. 25TH 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:
90810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-673-2406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2008