Provider First Line Business Practice Location Address:
3950 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-8001
Provider Business Practice Location Address Fax Number:
562-424-5570
Provider Enumeration Date:
11/18/2005