| NPI | 1962586487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY EUGENE FORD Medical Director 310-635-2223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |