| NPI | 1629630314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN JOHNSON Owner 209-405-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |