Provider First Line Business Practice Location Address:
723 E 9TH 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:
90813-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-491-2797
Provider Business Practice Location Address Fax Number:
562-491-0945
Provider Enumeration Date:
10/22/2014