| NPI | 1356640783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEE L. WAITE Director 916-492-2110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A79238) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |