| NPI | 1912907114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA J WARNER Admin COO Rdinator 909-865-9501 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2025-09-04 |