Provider First Line Business Practice Location Address:
221 E BARCLAY ST
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:
90805-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-590-5630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2024