Provider First Line Business Practice Location Address:
3300 E. SOUTH STREET
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-634-9803
Provider Business Practice Location Address Fax Number:
562-634-9845
Provider Enumeration Date:
09/08/2006