Provider First Line Business Practice Location Address:
1260 E 2ND ST
Provider Second Line Business Practice Location Address:
APT 9
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90802-5770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-852-7325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2016