| NPI | 1992063077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONDLE BENNETT Owner 209-890-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WA CH00003565) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |