| NPI | 1154656254 |
|---|---|
| Doing Business As | KINGS WINERY MEDICLA CLINIC |
| Entity Type | Organization |
| Authorized Contact | BLA MOUANOUTOUA CEO 559-255-6476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 040000336) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2024-04-29 |