Provider First Line Business Practice Location Address:
1666 MEDICAL CENTER DR STE 3
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:
92411-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-881-5007
Provider Business Practice Location Address Fax Number:
951-689-4800
Provider Enumeration Date:
04/18/2010