Provider First Line Business Practice Location Address:
944 PACIFIC AVE
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:
90813-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-436-3533
Provider Business Practice Location Address Fax Number:
562-436-0043
Provider Enumeration Date:
04/22/2011