Provider First Line Business Practice Location Address:
2725 PACIFIC AVENUE
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:
90806-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-427-7493
Provider Business Practice Location Address Fax Number:
562-424-1833
Provider Enumeration Date:
02/13/2007