Provider First Line Business Practice Location Address:
2340 E PACIFIC COAST HWY STE F
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:
90804-1574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-986-4430
Provider Business Practice Location Address Fax Number:
562-597-7982
Provider Enumeration Date:
10/24/2006