Provider First Line Business Practice Location Address:
221 E BARCLAY 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-416-3254
Provider Business Practice Location Address Fax Number:
562-860-4865
Provider Enumeration Date:
04/27/2023