| NPI | 1124405881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MILLER Director 888-417-5163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA 960001448) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2023-11-15 |