| NPI | 1215579222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WHITAKER MAXEY Medical Director 310-680-1810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2019-10-10 |