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1104097823
BENNIE GORDON
COLTON, CA
NPI
1104097823
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
164X00000X Licensed Vocational Nurse
(Licence: CA 176537)
Enumeration Date
2008-03-20
Last Update Date
2008-03-20
Business Address
-- BENNIE GORDON
400 N PEPPER AVE
COLTON, CA 92324-1801
Phone number: 909-580-1800
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Mailing Address
-- BENNIE GORDON
400 N PEPPER AVE
COLTON, CA 92324-1801
Phone number: 909-580-1800
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