Individual
MR. RUSSELL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1412 LIATRIS WAY, BEAUMONT, CA 92223-8468
(951) 769-1241
Mailing address
1412 LIATRIS WAY, BEAUMONT, CA 92223-8468
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
515669CA
CA
Other
Enumeration date
10/28/2008
Last updated
10/28/2008
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