| NPI | 1487765103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS LOGAN JACKSON Owner 812-376-8997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IN 01046379A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-12-04 |