| NPI | 1164846945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL R. BUSBY Executive Administrator 574-296-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |