Provider First Line Business Practice Location Address:
900 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
50 M ATHLETICS AND DANCE
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92521-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-827-3813
Provider Business Practice Location Address Fax Number:
951-827-7158
Provider Enumeration Date:
10/10/2014