| NPI | 1649337338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA JEAN BAXTER Chief Executive Officer 1408-716-8101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 14217) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2010-05-20 |