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1184959173
COLLIS SMITH
SAN BERNARDINO, CA
NPI
1184959173
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
167G00000X Licensed Psychiatric Technician
(Licence: CA 34214)
Enumeration Date
2009-10-08
Last Update Date
2009-10-08
Business Address
COLLIS SMITH
2080 S E ST
SAN BERNARDINO, CA 92408-2706
Phone number: 909-825-8989
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Mailing Address
COLLIS SMITH
11650 CHERRY AVE
FONTANA, CA 92337-2786
Phone number: 909-904-9465
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