Provider First Line Business Practice Location Address:
5378 LONG BEACH BLVD STE 136
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:
90805-5858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-519-9657
Provider Business Practice Location Address Fax Number:
562-519-9657
Provider Enumeration Date:
12/24/2025