Provider First Line Business Practice Location Address:
1040 ELM AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-624-1111
Provider Business Practice Location Address Fax Number:
562-624-1115
Provider Enumeration Date:
03/27/2015