Provider First Line Business Practice Location Address:
2146 E 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:
90804-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-439-7227
Provider Business Practice Location Address Fax Number:
562-438-4737
Provider Enumeration Date:
09/15/2006