| NPI | 1396580767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK NEWMAN Medical Director 317-902-9541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-06-27 |