Provider First Line Business Practice Location Address:
1060 E 70TH 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:
90805-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-531-7284
Provider Business Practice Location Address Fax Number:
562-531-7842
Provider Enumeration Date:
01/22/2008