Provider First Line Business Practice Location Address:
1305 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:
90806-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-938-3992
Provider Business Practice Location Address Fax Number:
562-938-3103
Provider Enumeration Date:
04/25/2016