Provider First Line Business Practice Location Address:
1183 E ANAHEIM 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:
90813-3662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-599-6600
Provider Business Practice Location Address Fax Number:
562-218-5596
Provider Enumeration Date:
05/11/2007