| NPI | 1265272736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRTRINA JONES Director Of Credentialing 909-294-3915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-10-16 |