Provider First Line Business Practice Location Address:
900 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SOM ED. BLDG. II
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-827-4618
Provider Business Practice Location Address Fax Number:
951-263-7238
Provider Enumeration Date:
12/05/2023