| NPI | 1366790347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE THOMPSON Business Administrator 888-417-5163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: CA CMM71069F) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QF0050X Clinic/Center, Family Planning, Non-Surgical | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2012-08-22 |