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 |