| NPI | 1295089621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDE J MOMODU CEO 317-493-1053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01057399A) |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2020-06-03 |