| NPI | 1275350167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE DOLE Manger 209-575-4575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |