| NPI | 1497061469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JACOBS Director Of Operations 800-774-9251 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 35725) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2010-08-27 |