| NPI | 1215102215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAVONIA SIDONEY RUSSELL Director 310-462-6082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA FNP 38172) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2009-02-19 |