Provider First Line Business Practice Location Address:
1309 E SOMERSET PL
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:
90807-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-773-1961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2021