| NPI | 1659644987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NGUYEN VU President 317-506-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME109751) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2013-02-04 |