| NPI | 1154874964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK WIESEN CEO 916-441-2811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CA 030000523) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |