| NPI | 1205405925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BENSON Interim CEO/Medical Director 317-580-6304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2021-06-18 |