| NPI | 1194121541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY BUCKLEY Owner 317-513-2386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IN 2330496686) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2014-11-13 |