| NPI | 1720172174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTON N KOJOUHAROV Medical Doctor 765-674-3321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: IN 01035651) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |