| NPI | 1194025957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KADIE LEE Authorized Official 909-979-4493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2021-01-17 |