ANDREW MELBON GULTOM

BANNING, CA
NPI1518159409
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: CA  1013)
Enumeration Date2007-08-14
Last Update Date2007-08-14
Business Address
MR. ANDREW MELBON GULTOM COTA
1065 DRIFTWOOD CIR
BANNING, CA 92220-6321
Phone number: 909-856-6625
Mailing Address
MR. ANDREW MELBON GULTOM COTA
1065 DRIFTWOOD CIR
BANNING, CA 92220-6321
Phone number: 909-856-6625