| NPI | 1093157604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN DOONAN Medical Director 855-812-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: CA A78014) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |