Provider First Line Business Practice Location Address:
1638 E ARTESIA BLVD
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:
90805-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-256-2483
Provider Business Practice Location Address Fax Number:
562-256-2496
Provider Enumeration Date:
01/29/2007