Provider First Line Business Practice Location Address:
1237 E 6TH 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:
90802-7039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-294-1775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2026