| NPI | 1275691339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN RUSSAKOV President 290-574-1355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1800X Clinic/Center, Corporate Health (Licence: CA G75606) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |