Provider First Line Business Practice Location Address:
920 PACIFIC 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:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-495-3985
Provider Business Practice Location Address Fax Number:
562-495-3452
Provider Enumeration Date:
09/27/2006