Provider First Line Business Practice Location Address:
6400 E SPRING ST
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:
90815-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-425-2713
Provider Business Practice Location Address Fax Number:
562-425-9713
Provider Enumeration Date:
05/11/2010