| NPI | 1205016599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI LYNN MANN Owner 317-833-0657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IN 26019885A) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 26021115A) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |