Provider First Line Business Practice Location Address:
5199 E PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE# 604
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-508-3838
Provider Business Practice Location Address Fax Number:
562-597-5692
Provider Enumeration Date:
08/31/2006