| NPI | 1053638601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ANDERSON TERRELL President/Owner 909-548-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA 20A8506) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2010-11-09 |