| NPI | 1508266826 |
|---|---|
| Doing Business As | BLACK RIVER FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NC 2006-01488) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2014-08-25 |