| NPI | 1376730150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENNIE KWOCK Manager 805-884-1629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA N4473383) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2007-09-26 |