| NPI | 1104327543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILSON D GOMER President 909-802-9374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: CA A50690) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2018-06-06 |