Provider First Line Business Practice Location Address:
1939 SHIPWAY AVE
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:
90815-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-728-3431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2010