Provider First Line Business Practice Location Address:
2153 PACIFIC AVENUE
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:
90806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-599-4833
Provider Business Practice Location Address Fax Number:
563-599-6366
Provider Enumeration Date:
09/15/2006