| NPI | 1487805370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH M LEE Owner/Clinic Manager 20969-808-8672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: CA PA16158) |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2011-07-08 |