Provider First Line Business Practice Location Address:
4195 N VIKING WAY STE G
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:
90808-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-231-7352
Provider Business Practice Location Address Fax Number:
562-488-9686
Provider Enumeration Date:
02/19/2026