Provider First Line Business Practice Location Address:
5580 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 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:
90803-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-375-0451
Provider Business Practice Location Address Fax Number:
562-433-5522
Provider Enumeration Date:
10/14/2016