| NPI | 1427196476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN VAUN STONGER Owner 765-472-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IN 01031765A) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-09-28 |