| NPI | 1922450170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASAD V MADDUKURI Governing Member 617-319-1958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: TX P2895) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2020-02-28 |