Provider First Line Business Practice Location Address:
1627 E. ANAHEIM STREET
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:
90813-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-437-0373
Provider Business Practice Location Address Fax Number:
562-591-9646
Provider Enumeration Date:
07/27/2006