| NPI | 1003397936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI A BURNETT Billing Manager 909-793-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A68895) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |