Organization
PROTOTYPES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA WOLSKY (SUPERVISOR)
(909) 398-4383
Entity
Organization
Contact information
Practice address
831 E ARROW HWY, POMONA, CA 91767-2535
(909) 398-4383
Mailing address
831 E ARROW HWY, POMONA, CA 91767-2535
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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