| NPI | 1912293580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE ABNEY Executive Director 760-722-0672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CA 123709) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |