Provider First Line Business Practice Location Address:
8000 E BYNUM 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:
90808-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-309-0961
Provider Business Practice Location Address Fax Number:
562-795-5965
Provider Enumeration Date:
02/23/2006