| NPI | 1275707366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEJAUN BLEDSOE Staff Assistant 562-940-3694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 171M00000x) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2008-04-18 |