Provider First Line Business Practice Location Address:
130 W. ANAHEIM 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:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-901-9999
Provider Business Practice Location Address Fax Number:
562-901-1120
Provider Enumeration Date:
10/08/2012