| NPI | 1679934475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEEPTI THAPAR Md 319-573-7313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: PA MD444916) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2018-01-22 |