Provider First Line Business Practice Location Address:
1466 1/2 ALAMITOS AVE
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:
90813-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-209-0131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2023