| NPI | 1811232770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN TRUONG Manager 917-300-8296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: NY 254736) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2012-12-04 |