Provider First Line Business Practice Location Address:
823 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-432-1532
Provider Business Practice Location Address Fax Number:
562-432-6732
Provider Enumeration Date:
02/26/2007