Provider First Line Business Practice Location Address:
2841 GOLDEN 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:
90806-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-8989
Provider Business Practice Location Address Fax Number:
562-306-1135
Provider Enumeration Date:
07/21/2022