Provider First Line Business Practice Location Address:
5150 E PAC COAST HWY
Provider Second Line Business Practice Location Address:
460
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-7100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-473-5371
Provider Business Practice Location Address Fax Number:
805-474-9054
Provider Enumeration Date:
07/27/2006