Provider First Line Business Practice Location Address:
4029 E ANAHEIM 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:
90804-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-494-4421
Provider Business Practice Location Address Fax Number:
562-494-2731
Provider Enumeration Date:
09/25/2008