Provider First Line Business Practice Location Address:
4647 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
#A4
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-438-8825
Provider Business Practice Location Address Fax Number:
562-433-2007
Provider Enumeration Date:
02/06/2006