Provider First Line Business Practice Location Address:
1975 LONG BEACH BLVD.
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:
90806-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-218-4044
Provider Business Practice Location Address Fax Number:
562-599-3934
Provider Enumeration Date:
11/29/2006