| NPI | 1255450979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LAKES Executive Director 909-891-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 42378) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2008-06-26 |