Provider First Line Business Practice Location Address:
130 W. ANAHEIM STREET
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:
90813-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-893-9794
Provider Business Practice Location Address Fax Number:
213-251-8909
Provider Enumeration Date:
10/10/2013