| NPI | 1417130881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANDREW FAGAN Owner 909-982-7741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA G060968) |
| Enumeration Date | 2007-12-08 |
| Last Update Date | 2013-02-04 |