Organization
1ST SOURCE MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VILLARD MCCOY (OWNER)
(951) 350-4020
Entity
Organization
Contact information
Practice address
1123 W 9TH ST, UPLAND, CA 91786-5704
(951) 350-4020
(951) 350-4012
Mailing address
1123 W 9TH ST, UPLAND, CA 91786-5704
(951) 350-4020
(951) 350-4012
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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