Provider First Line Business Practice Location Address:
2295 S VINEYARD AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ORTHOPEDICS, BLDG D
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91761-7925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-405-3697
Provider Business Practice Location Address Fax Number:
877-514-0903
Provider Enumeration Date:
11/05/2007