Provider First Line Business Practice Location Address:
455 E COLUMBIA ST
Provider Second Line Business Practice Location Address:
201 & 6
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-276-3650
Provider Business Practice Location Address Fax Number:
562-933-0487
Provider Enumeration Date:
05/31/2012