| NPI | 1164669206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANTHONY TRAUB CEO 1337-436-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: LA 014217) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-13 |