| NPI | 1568979961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN KONING Owner 951-317-4301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX Q0953) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: TX Q0953) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-04-02 |