| NPI | 1891705596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK WIESEN CEO 916-441-2811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 030000534) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-04-24 |