Provider First Line Business Practice Location Address:
8225 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-1056
Provider Business Practice Location Address Fax Number:
323-587-1671
Provider Enumeration Date:
08/24/2006