Provider First Line Business Practice Location Address:
3221 EASY 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:
90810-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-2771
Provider Business Practice Location Address Fax Number:
562-685-0130
Provider Enumeration Date:
09/11/2026