Provider First Line Business Practice Location Address:
5603 E 2ND 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:
90803-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-243-6548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2013