Provider First Line Business Practice Location Address:
2801 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
RESEARCH ADMINISTRATION
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-480-6725
Provider Business Practice Location Address Fax Number:
562-490-3738
Provider Enumeration Date:
04/04/2007