Provider First Line Business Practice Location Address:
3125 E 3RD 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:
90814-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-893-7399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2014