| NPI | 1881106573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON EDWARD BOGGS President 209-233-9038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A77822) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |