Provider First Line Business Practice Location Address:
8200 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
UNIT D-2
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-537-2837
Provider Business Practice Location Address Fax Number:
323-537-4940
Provider Enumeration Date:
08/29/2015