Provider First Line Business Practice Location Address:
1299 E WARDLOW RD
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:
90807-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-0423
Provider Business Practice Location Address Fax Number:
562-427-4253
Provider Enumeration Date:
11/14/2005