Provider First Line Business Practice Location Address:
2272 PACIFIC AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-988-2137
Provider Business Practice Location Address Fax Number:
562-424-7413
Provider Enumeration Date:
07/27/2006