| NPI | 1629541685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EURAL E. GORDON Owner 661-321-9138 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine |
| 207QA0505X Family Medicine Adult Medicine | |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2019-02-05 |