| NPI | 1861732190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NDIKA FOMUKONG Chief Executive Officer 310-701-6703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 2768722) |
| Enumeration Date | 2013-02-23 |
| Last Update Date | 2013-02-23 |