Provider First Line Business Practice Location Address:
4210 ATLANTIC AVE
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:
90807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-595-8507
Provider Business Practice Location Address Fax Number:
562-988-9220
Provider Enumeration Date:
06/13/2008