Provider First Line Business Practice Location Address:
750 E 29TH 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:
90806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-989-6455
Provider Business Practice Location Address Fax Number:
562-989-6454
Provider Enumeration Date:
09/01/2006