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Organization
PINE STREET CLINIC LLC
Active
Organization
PINE STREET CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BROFFMAN LAC (MEMBER)
(415) 485-0484
Entity
Organization
Contact information
Practice address
124 PINE ST, SAN ANSELMO, CA 94960-2602
(415) 485-0484
Mailing address
124 PINE ST, SAN ANSELMO, CA 94960-2602
(415) 485-0484
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1140
CA
Other
Enumeration date
03/08/2011
Last updated
03/08/2011
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