Provider First Line Business Practice Location Address:
4101 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:
90814-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-434-7260
Provider Business Practice Location Address Fax Number:
562-433-5058
Provider Enumeration Date:
04/26/2007