Provider First Line Business Practice Location Address: 
4234 RIVERWALK PARKWAY SUITE 230
    Provider Second Line Business Practice Location Address: 
PACIFIC PULMONARY MEDICAL GROUP
    Provider Business Practice Location Address City Name: 
RIVERSIDE
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92505
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
951-781-3672
    Provider Business Practice Location Address Fax Number: 
951-781-0365
    Provider Enumeration Date: 
06/25/2007