| NPI | 1497826804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA DAVIDSON Medical Office Manager 765-962-9541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IN 50000322) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-08-22 |