Provider First Line Business Practice Location Address:
2033 EAST 1ST STREET
Provider Second Line Business Practice Location Address:
APT 2C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-470-0532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2022