Provider First Line Business Practice Location Address:
2101 N WATERMAN AVE
Provider Second Line Business Practice Location Address:
MEDICAL STAFF OFFICE
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-290-1746
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2015