| NPI | 1174746127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON M HALL Owner 812-479-3834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01050887A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 35496) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |