| NPI | 1992975718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL WANDEL CFO 209-373-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-04-20 |