| NPI | 1124191804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALDO BACCALA Execuitve Officer 707-778-6719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC HAL-049-023) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |