Provider First Line Business Practice Location Address:
1040 ELM AVE
Provider Second Line Business Practice Location Address:
SUITES 101 AND 105
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-547-0202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2026