| NPI | 1467436048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Credentialing Specialist 209-385-5434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 030000554) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2011-12-13 |