| NPI | 1144475864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY J MCNICOLL President/Owner 805-527-6424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G48100) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2009-02-03 |