NPI | 1518313642 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID CHRISTOPHER WOOD Doctor 317-590-2957 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 12012123A) |
Enumeration Date | 2016-05-07 |
Last Update Date | 2016-05-07 |