| NPI | 1306122551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DOMINIC PAQUETTE Medical Director 916-341-0310 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2021-06-14 |