Provider First Line Business Practice Location Address:
6770 N PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
UNIT #A
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-668-3557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2010