Provider First Line Business Practice Location Address:
2268 LONG BEACH 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:
90806-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-5531
Provider Business Practice Location Address Fax Number:
562-426-6773
Provider Enumeration Date:
11/28/2006