Provider First Line Business Practice Location Address:
3559 E SOUTH 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:
90805-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-354-4410
Provider Business Practice Location Address Fax Number:
888-972-1912
Provider Enumeration Date:
12/16/2019