| NPI | 1144310657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA AIMEE SCHULLY Physician/Owner 209-575-2344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G842150) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-22 |