| NPI | 1396804191 |
|---|---|
| Other Name | 4452 E KINGS CANYON RD SUD |
| Entity Type | Organization |
| Authorized Contact | SUSAN L HOLT Director Of Behavioral Health/Publi 559-600-9058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2023-11-30 |