| NPI | 1801991450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAGIAN SUN President 909-825-3202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A23744) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |