| NPI | 1306048590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFORY LORN THROGMORTON Owner 707-443-8838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 126801773) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |