| NPI | 1376957753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KILEY ERTEL Medical Director 317-577-2777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 01049468A) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2014-06-13 |