| NPI | 1194865642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE CAROL BALES President 812-330-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 010470453) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01060196A) |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10000690A) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |