Provider First Line Business Practice Location Address:
2153 W HILL ST
Provider Second Line Business Practice Location Address:
(REID CONTINUATION HIGH SCHOOL)
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90810-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-532-0063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012