Provider First Line Business Practice Location Address:
2250 E CARSON 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:
90807-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-490-0201
Provider Business Practice Location Address Fax Number:
562-492-9884
Provider Enumeration Date:
01/27/2014