Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN GLYN PAWSON MR (OWNER)
(916) 792-0141
Entity
Organization
Contact information
Practice address
3146 BENHAM CT, PLACERVILLE, CA 95667-6442
(916) 792-1041
(916) 792-1041
Mailing address
3146 BENHAM CT, PLACERVILLE, CA 95667-6442
(916) 792-1041
(916) 792-1041
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
NOT REQUIRED
CA
Other
Enumeration date
07/21/2015
Last updated
07/21/2015
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