| NPI | 1073531976 |
|---|---|
| Doing Business As | COUNTY LINE MEDICAL PAVILION |
| Entity Type | Organization |
| Authorized Contact | JEFFERY KIRKHAM CFO 317-355-5822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 207V00000X Obstetrics & Gynecology | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2010-03-29 |