| NPI | 1588021158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUNNA POURANG Medical Director 424-265-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A133046) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |