Provider First Line Business Practice Location Address:
1100 OHIO AVE
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-544-2092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2012