| NPI | 1801945340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ANTHONY LONG Clinical Supervisor 619-440-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable (Licence: CA 45528007) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |