Provider First Line Business Practice Location Address:
1645 CLARK AVE UNIT 116
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:
90815-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-961-9146
Provider Business Practice Location Address Fax Number:
562-961-9146
Provider Enumeration Date:
06/07/2007