| NPI | 1518915776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAM Q NGUYEN President/Owner 317-924-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IN 60004479A) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-08-22 |