| NPI | 1265272736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRTRINA JONES Credentialing/Contracting Manager 909-946-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-05-30 |