Provider First Line Business Practice Location Address:
1425 W SPRING ST
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:
90810-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-746-6963
Provider Business Practice Location Address Fax Number:
562-513-3446
Provider Enumeration Date:
04/05/2022