| NPI | 1982975959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNIL M SHIVARAM Medical Director 909-624-8077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2023-09-19 |