| NPI | 1053663138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON HANNON Manager 219-326-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IN 28173025A) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |