| NPI | 1528941762 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | RAHUL GAJJALA CEO 872-325-3100 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care | 
| Additional Taxonomies | 261Q00000X Clinic/Center | 
| Enumeration Date | 2025-07-28 | 
| Last Update Date | 2025-07-28 |