Provider First Line Business Practice Location Address:
5523 E CARITA 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:
90808-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-714-4998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2025