| NPI | 1558575951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THONGDANG BANCHUIN President 276-679-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101029458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101029458) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2008-01-14 |