| NPI | 1013104470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RADHA VENKATRAMANAN Md/ President 270-889-0282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KY 39289) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2007-10-01 |