| NPI | 1699071753 |
|---|---|
| Other Name | FMG OF LLUSM-ED URGENT CARE |
| Entity Type | Organization |
| Authorized Contact | LISA WOLTER Provider Enrollment Rep 909-558-3289 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |