| NPI | 1164640454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MITCHELL Medical Director 909-881-2538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 240000756) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |