Provider First Line Business Practice Location Address:
1027 LINDEN AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-624-4949
Provider Business Practice Location Address Fax Number:
562-491-9059
Provider Enumeration Date:
09/14/2006