Provider First Line Business Practice Location Address:
1711 1/2 E 5TH 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:
90802-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-313-5975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2024