Provider First Line Business Practice Location Address:
8330 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-947-7547
Provider Business Practice Location Address Fax Number:
323-973-1733
Provider Enumeration Date:
06/29/2010