| NPI | 1558301713 |
|---|---|
| Doing Business As | COFFEE ROAD CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | STEVEN A MITNICK Medical Director 209-521-6097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-05-06 |