| NPI | 1043481450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR HUGO FANTASIA CFO 909-986-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: CA 15464) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |