Provider First Line Business Practice Location Address:
VA LONG BEACH HCS ATTN: JESSICA AVILA GEC/CLC
Provider Second Line Business Practice Location Address:
MAILSTOP:08/118 5901 EAST 7TH STREET
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-706-9228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2022