Provider First Line Business Practice Location Address:
3620 LONG BEACH BLVD STE C3
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:
90807-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-352-4916
Provider Business Practice Location Address Fax Number:
562-261-1279
Provider Enumeration Date:
06/22/2026