| NPI | 1104195098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER RUTHERFORD Credentialing Coordinator 317-837-5566 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1800X Clinic/Center, Corporate Health |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2024-04-16 |