Provider First Line Business Practice Location Address:
1225 E WARDLOW RD
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:
90807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-997-0966
Provider Business Practice Location Address Fax Number:
562-981-6637
Provider Enumeration Date:
12/18/2007