Provider First Line Business Practice Location Address:
3545 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-595-0060
Provider Business Practice Location Address Fax Number:
562-981-0916
Provider Enumeration Date:
06/26/2006