| NPI | 1003816307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY ATKINSON BROUILLETTE Administrator Don 765-474-7838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IN 05-006126-1) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2025-04-22 |