Provider First Line Business Practice Location Address:
6060 N PARAMOUNT BLVD
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:
90805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-634-9534
Provider Business Practice Location Address Fax Number:
562-790-1867
Provider Enumeration Date:
09/21/2010