Provider First Line Business Practice Location Address:
6226 E SPRING ST
Provider Second Line Business Practice Location Address:
240
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-928-7129
Provider Business Practice Location Address Fax Number:
562-938-7431
Provider Enumeration Date:
12/23/2013