| NPI | 1912215492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY T BOWERS Provider 951-695-1477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA C0965984) |
| Enumeration Date | 2010-09-19 |
| Last Update Date | 2010-09-19 |