| NPI | 1245621259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STAN SHARMA C E O 166-125-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CA 1234) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |