| NPI | 1336585744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN M ROY Billing Director 657-304-0103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2020-05-07 |