Organization
AVANTI-AYUSH, LLC
Active
Other names
The Vintage
Organization subpart
No
Provider details
NPI number
Authorized official
SUBODH MALLIK M.D. (OWNER)
(432) 290-2510
Entity
Organization
Contact information
Practice address
237 W 21ST ST, FORT STOCKTON, TX 79735-2536
(432) 290-2510
Mailing address
1609 WESTWIND DR., FORT STOCKTON, TX 79735-2515
(432) 290-2510
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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