| NPI | 1881690949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZI MICHELLE CUNNINGHAM Administrator 909-560-5125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA 550000011) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-08-20 |