Provider First Line Business Practice Location Address:
5584 N PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-5133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-920-8394
Provider Business Practice Location Address Fax Number:
562-867-6083
Provider Enumeration Date:
02/15/2006