| NPI | 1558757559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVON B CHATMAN Operations Manager 310-990-9390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 32710) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-04-07 |