Provider First Line Business Practice Location Address:
800 E WARDLOW RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-4651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-256-9961
Provider Business Practice Location Address Fax Number:
562-256-9981
Provider Enumeration Date:
07/15/2005