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1790707156
EDGAR RUSSELL
RIVERSIDE, CA
NPI
1790707156
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207QA0505X Family Medicine, Adult Medicine
(Licence: CA 20A6100)
Enumeration Date
2006-07-24
Last Update Date
2007-07-09
Business Address
-- EDGAR RUSSELL D.O.
6276 RIVER CREST DR
RIVERSIDE, CA 92507-0754
Phone number: 951-413-0964
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Mailing Address
-- EDGAR RUSSELL D.O.
1413 CALLE DE ORO
SAN DIMAS, CA 91773-4015
Phone number: 909-592-4566
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