| NPI | 1245628411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELESTE CLARK Program Director 916-640-8050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: ID N-45751) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |