Organization
WITHROW OUT A TRACE MINISTYR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT M DUGAN REGISTER COUNSELOR (COUNSELOR)
(213) 880-9242
Entity
Organization
Contact information
Practice address
2110 ARTESIA BLVD, REDONDO BEACH, CA 90278-3073
(310) 569-5868
Mailing address
4015 W 137TH ST, HAWTHORNE, CA 90250-7340
(310) 569-5868
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
RW2056
CA
Other
Enumeration date
04/03/2009
Last updated
04/03/2009
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