| NPI | 1871779934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HELEN ROEHLK Adm Assist Credentialing 209-385-5434 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 550000302) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |