| NPI | 1508148131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY STEVEN EDGECOMBE Clinic Director 765-359-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IN 08002570A) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |