| NPI | 1356468631 |
|---|---|
| Doing Business As | GRAND AVENUE PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | ANTHONY SHOWALTER President Of The Board Of Directors 812-254-8620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2021-01-02 |