Provider First Line Business Practice Location Address:
701 E 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-2759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-0338
Provider Business Practice Location Address Fax Number:
562-427-7766
Provider Enumeration Date:
05/24/2006