| NPI | 1861292815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAHUL GAJJALA Vice President 872-325-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-07-24 |