Provider First Line Business Practice Location Address:
701E 28TH ST 116
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:
90806-2771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-8111
Provider Business Practice Location Address Fax Number:
562-912-4500
Provider Enumeration Date:
07/03/2006