Provider First Line Business Practice Location Address:
2772 E 2ND ST UNIT 1E
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:
90803-5157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-213-8278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2022