Provider First Line Business Practice Location Address:
2530 ATLANTIC AVE STE A
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:
90806-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-4598
Provider Business Practice Location Address Fax Number:
562-318-3042
Provider Enumeration Date:
07/15/2009