Provider First Line Business Practice Location Address:
395 E 4TH ST UNIT 24
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:
90802-0407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-822-2384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2023