Provider First Line Business Practice Location Address:
3620 LONG BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE C-8
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90807-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-1165
Provider Business Practice Location Address Fax Number:
562-424-6634
Provider Enumeration Date:
12/08/2006