Provider First Line Business Practice Location Address:
411 E PACIFIC COAST HWY
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:
90806-6218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-599-0981
Provider Business Practice Location Address Fax Number:
562-599-0996
Provider Enumeration Date:
09/20/2006