Provider First Line Business Practice Location Address:
5500 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-537-5495
Provider Business Practice Location Address Fax Number:
909-537-7002
Provider Enumeration Date:
08/11/2016