| NPI | 1124420757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA SULLIVAN Chief Executive Officer 765-423-5361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IN 33006734A) |
| Additional Taxonomies | 251S00000X (Licence: TX 39934) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |