Provider First Line Business Practice Location Address:
2527 SANTA FE 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:
90810-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-492-1148
Provider Business Practice Location Address Fax Number:
562-424-9848
Provider Enumeration Date:
01/13/2007