| NPI | 1407306665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY SCOTT JOHNSTON Owner/Operator 209-756-2275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G58698) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2022-04-27 |