| NPI | 1225504418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED DAVID JACKSON Emr Clinical Analyst 317-294-9682 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2018-10-16 |