| NPI | 1437649068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA K HICKS Provider Enrollment Coordinator 949-242-5592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0208X Clinic/Center, Radiology, Mobile |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-05-18 |