| NPI | 1902814049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUELLA BANGURA President/Owner 765-447-7941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01045193A) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-12-11 |