Provider First Line Business Practice Location Address:
3300 E SOUTH STREET
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:
91786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-232-1144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2009