| NPI | 1710170394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA BOELKE Supervisor 209-385-7840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 540215) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |