Provider First Line Business Practice Location Address:
8401 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-444-2660
Provider Business Practice Location Address Fax Number:
626-448-1002
Provider Enumeration Date:
01/15/2013