| NPI | 1225491426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIENGXAY MALAVONG Owner 334-203-1723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AL DO. 1492) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2016-04-04 |