| NPI | 1174801054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BURNETT RUCKER Medical Director 323-662-7764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A34349) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2011-07-27 |