Provider First Line Business Practice Location Address:
4200 N LAKEWOOD BLVD
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:
90808-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-420-1701
Provider Business Practice Location Address Fax Number:
562-421-8447
Provider Enumeration Date:
09/26/2022