| NPI | 1972148369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISTAL DAWN SPELLER President/CEO 818-551-0464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2020-06-30 |