Provider First Line Business Practice Location Address:
6845 LEMON AVE
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:
90805-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-822-3818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2025