| NPI | 1265100101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNDAR ALVIN DHAMOTHARAN Cmo 346-205-4388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2021-09-04 |