Provider First Line Business Practice Location Address:
6621 EAST PACIFIC COAST HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE # 220
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90803-3882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-335-9997
Provider Business Practice Location Address Fax Number:
562-434-9692
Provider Enumeration Date:
03/28/2007