Provider First Line Business Practice Location Address:
2200 E ANAHEIM ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-438-2031
Provider Business Practice Location Address Fax Number:
562-438-1457
Provider Enumeration Date:
09/20/2006