Provider First Line Business Practice Location Address:
5901 E 7TH 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:
90822-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-967-0211
Provider Business Practice Location Address Fax Number:
562-346-3594
Provider Enumeration Date:
09/06/2013