Provider First Line Business Practice Location Address:
2017 E 4TH 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:
90814-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-434-4455
Provider Business Practice Location Address Fax Number:
562-433-6428
Provider Enumeration Date:
09/29/2011