Provider First Line Business Practice Location Address:
676 E COOLIDGE 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:
90805-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-342-3092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2026