| NPI | 1114163987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY BRYAN GIN Director Of Clinical Services 510-269-9042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA 020000193) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2011-12-09 |