| NPI | 1093392870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KANE Board Member 812-804-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2021-12-01 |