Provider First Line Business Practice Location Address:
4100 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-2696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-3925
Provider Business Practice Location Address Fax Number:
562-595-7639
Provider Enumeration Date:
12/29/2006