| NPI | 1164448593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA GRAHAM Billing Manager 760-955-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA A87666) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-01-09 |