Provider First Line Business Practice Location Address:
2211 E 7TH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-439-6562
Provider Business Practice Location Address Fax Number:
562-375-6632
Provider Enumeration Date:
01/24/2024