| NPI | 1548659105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BALLUE Chief Compliance Officer 310-679-9126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2024-07-26 |