Provider First Line Business Practice Location Address:
432 E 10TH ST
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:
90813-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-756-4386
Provider Business Practice Location Address Fax Number:
310-326-3744
Provider Enumeration Date:
03/30/2011