Provider First Line Business Practice Location Address:
701 E 28TH ST STE 117
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:
90806-2772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-9890
Provider Business Practice Location Address Fax Number:
562-426-7809
Provider Enumeration Date:
07/26/2005