| NPI | 1871164517 |
|---|---|
| Former Legal Business Name | PHOEGENESIS, INC |
| Entity Type | Organization |
| Authorized Contact | CHARLES ELLIS President 909-576-2224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2021-07-04 |
| Last Update Date | 2021-07-04 |