Provider First Line Business Practice Location Address:
1190 N STUDEBAKER RD STE H
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:
90815-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-597-9402
Provider Business Practice Location Address Fax Number:
562-498-5802
Provider Enumeration Date:
08/30/2006