| NPI | 1003357377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES L. PORILE Authorized Official 574-273-6787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-03-10 |