Provider First Line Business Practice Location Address:
4195 N VIKING WAY
Provider Second Line Business Practice Location Address:
SUITE F
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-420-2112
Provider Business Practice Location Address Fax Number:
562-420-2110
Provider Enumeration Date:
12/10/2014