| NPI | 1174570964 |
|---|---|
| Doing Business As | FAIRMONT AVE CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | STEVEN A MITNICK Medical Director 209-521-6097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2010-05-06 |