| NPI | 1124213319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FREMONT WIDDIFIELD Administrator 317-787-7902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN IN01017158) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-09-11 |