Provider First Line Business Practice Location Address:
5500 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
C/O PSYCHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92407-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-537-5947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007