| NPI | 1720233463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENICE LORENA STANIFORD Therapist 619-286-0677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA MLO21394) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2008-11-21 |