Provider First Line Business Practice Location Address:
612 E CARSON 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:
90807-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-987-0626
Provider Business Practice Location Address Fax Number:
562-987-1767
Provider Enumeration Date:
04/13/2016