| NPI | 1235146812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MICHELLE HOLTSCLAW Member 260-432-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02001568a) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |