Provider First Line Business Practice Location Address:
3738 1/2 LEMON 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:
90807-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-480-3696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2024