Provider First Line Business Practice Location Address:
342 E 4TH 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:
90802-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-366-4286
Provider Business Practice Location Address Fax Number:
562-435-3331
Provider Enumeration Date:
09/30/2010