Provider First Line Business Practice Location Address:
2211 FASHION 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:
90810-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-612-3517
Provider Business Practice Location Address Fax Number:
562-612-1368
Provider Enumeration Date:
06/29/2011