| NPI | 1518179167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS WREGE Sole Proprietor Administrator 317-283-8113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 01056999A) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2008-06-25 |