Provider First Line Business Practice Location Address:
5050 E GARFORD ST
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-2865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-216-3542
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2014