| NPI | 1265521488 |
|---|---|
| Doing Business As | KINGS WINERY MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | BLA MOUANOUTOUA CEO 559-255-6476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 04000036) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2024-04-29 |