| NPI | 1083472369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL ANNETTE WATHEN CFO 812-450-3296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-11 |