| NPI | 1174295364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DOREUS General Manager 760-805-6602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1102X Clinic/Center, Military Outpatient Operational (Transportable) Component |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-12 |