Provider First Line Business Practice Location Address:
5604 LA PAZ 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:
90803-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-743-7800
Provider Business Practice Location Address Fax Number:
562-961-3529
Provider Enumeration Date:
02/25/2013