Provider First Line Business Practice Location Address:
5752 E 2ND 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:
90803-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-386-1342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2025