| NPI | 1265765861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERY D TARASENKO Medical Director 707-359-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA A72444) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |