Provider First Line Business Practice Location Address:
6685 DOWNEY AVE
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:
90805-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-630-4572
Provider Business Practice Location Address Fax Number:
562-630-1646
Provider Enumeration Date:
02/09/2007