Provider First Line Business Practice Location Address:
8204 LONG BEACH BLVD UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-3300
Provider Business Practice Location Address Fax Number:
323-588-0855
Provider Enumeration Date:
10/15/2024