| NPI | 1205507415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INDIGO ALLENDORF Executive Director 657-422-7586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |