| NPI | 1699506121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA BUIE Credentialing Coordinator 707-825-4182 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |