Provider First Line Business Practice Location Address:
240 E. 20TH 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:
90806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-218-4096
Provider Business Practice Location Address Fax Number:
562-218-0372
Provider Enumeration Date:
11/29/2006