Provider First Line Business Practice Location Address:
5820 DOWNEY AVENUE
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:
90805-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-663-0788
Provider Business Practice Location Address Fax Number:
562-663-0794
Provider Enumeration Date:
07/18/2006