| NPI | 1609171917 |
|---|---|
| Doing Business As | MOHAWK HEALTHY LIFE CENTER AT ANTIOCH |
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: GA RN213704) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2021-05-03 |