| NPI | 1295138642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEE LAZAR Medical Director 909-709-6826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A66921) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |