| NPI | 1760684526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MARCUS WILMOTH Secretary 415-595-6734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: CA G86894) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2009-03-23 |