| NPI | 1881703080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVERE GARETH WOOTTON Medical Director 310-315-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA 930000639) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |