| NPI | 1154766566 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | WILLIAM LEE HATHAWAY President 760-340-1264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2015-05-14 |