| NPI | 1457649857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN DIVINE Manager 812-295-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 08002579A) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-07-19 |