NPI | 1841916889 |
---|---|
Doing Business As | GRAVENSTEIN SOUTH |
Entity Type | Organization |
Authorized Contact | VIKKI MINNIFIELD Billing Manager 707-271-7052 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2022-10-12 |
Last Update Date | 2022-10-12 |