Provider First Line Business Practice Location Address:
1050 LINDEN 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:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-491-9755
Provider Business Practice Location Address Fax Number:
562-491-9691
Provider Enumeration Date:
12/28/2006