| NPI | 1194940080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE WAGONER Administrator 765-566-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2009-05-15 |