Provider First Line Business Practice Location Address:
834 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90802-7212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-590-9932
Provider Business Practice Location Address Fax Number:
562-590-9932
Provider Enumeration Date:
08/21/2006