| NPI | 1477981934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WINDY WATT Owner 765-301-9288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 71002641A) |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2013-10-25 |