Provider First Line Business Practice Location Address:
5855 E. 2ND STREET
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-266-7284
Provider Business Practice Location Address Fax Number:
562-433-4342
Provider Enumeration Date:
09/01/2006