| NPI | 1346533783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN LAGERKVIST Physician/Owner 765-613-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01059613A) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-11-22 |