Provider First Line Business Practice Location Address:
3500 E PACIFIC COAST HWY
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:
90804-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
565-494-4983
Provider Business Practice Location Address Fax Number:
562-494-3408
Provider Enumeration Date:
02/25/2012