Provider First Line Business Practice Location Address:
3200 E 19TH 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:
90755-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-494-7687
Provider Business Practice Location Address Fax Number:
562-494-7817
Provider Enumeration Date:
05/01/2007