Provider First Line Business Practice Location Address:
4500 E. PACIFIC COAST HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-344-1140
Provider Business Practice Location Address Fax Number:
562-685-0735
Provider Enumeration Date:
11/02/2006