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1366089377
LIONEL HERBERT CLACK
COVINA, CA
NPI
1366089377
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
163W00000X Registered Nurse
(Licence: CA 724717)
Enumeration Date
2019-12-09
Last Update Date
2019-12-09
Business Address
LIONEL HERBERT CLACK
1161 E COVINA BLVD
COVINA, CA 91724-1523
Phone number: 626-859-5275
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Mailing Address
LIONEL HERBERT CLACK
14094 MARICOPA RD
VICTORVILLE, CA 92392-9777
Phone number: 760-792-1212
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