| NPI | 1366297061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA MOFFITT Administrative Supervisor I 909-777-0726 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |