| NPI | 1982991279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA R GAVNEY Owner 650-814-0056 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 1040251-6-AFC) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |