| NPI | 1245583509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY S NISSEN Owner 619-886-5057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy (Licence: CA A77209) |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy (Licence: CA 532252) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2013-04-03 |