Provider First Line Business Practice Location Address:
501 E 27TH ST
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-595-5752
Provider Business Practice Location Address Fax Number:
562-595-1471
Provider Enumeration Date:
10/18/2006