| NPI | 1235461054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES E KELLY Registered Agent 765-430-4710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |