| NPI | 1437348778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL BRUNKAN Office Manager 888-362-2968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA W17289) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2007-10-23 |