| NPI | 1447612114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAZIA M SIDDIQUI Manager 765-714-4344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IN 01059790A) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-08-12 |