Provider First Line Business Practice Location Address:
600 E OCEAN BLVD
Provider Second Line Business Practice Location Address:
400B
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90802-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-987-3535
Provider Business Practice Location Address Fax Number:
562-983-7367
Provider Enumeration Date:
08/20/2012