Organization
INTERSPORT FITNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORETTA GARCIA LAUGHLIN CPT (OWNER)
(209) 480-9309
Entity
Organization
Contact information
Practice address
4847 STRATOS WAY, MODESTO, CA 95356-9544
(209) 522-9309
Mailing address
4847 STRATOS WAY, MODESTO, CA 95356-9544
(209) 522-9309
(209) 522-9365
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
164631
CA
Other
Enumeration date
10/10/2011
Last updated
10/13/2011
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