| NPI | 1295573194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY VIRES Owner, Authorized Official 317-654-3487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2024-07-16 |