Provider First Line Business Practice Location Address:
3424 E 4TH 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:
90814-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-631-7938
Provider Business Practice Location Address Fax Number:
714-828-1868
Provider Enumeration Date:
10/14/2013