Provider First Line Business Practice Location Address:
4137 E 7TH ST
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:
90804-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-433-7652
Provider Business Practice Location Address Fax Number:
562-433-8152
Provider Enumeration Date:
01/26/2017