| NPI | 1669689568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ALLEN DEVORE Clinic Administrator 707-971-9364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2008-07-08 |