| NPI | 1194277434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M FORTUNATO Director 317-536-1351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: LA 2203783118) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2021-11-22 |