| NPI | 1124154331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAIL BAKDASH President 765-208-0823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01047723A) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2020-08-22 |