Provider First Line Business Practice Location Address:
2403 ATLANTIC AVE
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:
90806-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-983-0547
Provider Business Practice Location Address Fax Number:
805-983-0423
Provider Enumeration Date:
03/31/2011