Provider First Line Business Practice Location Address:
5977 EAST SPRING STREET
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:
90808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-241-8041
Provider Business Practice Location Address Fax Number:
657-276-4734
Provider Enumeration Date:
04/14/2017