| NPI | 1538257167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY E. MACKEN-MARBLE Executive Director 574-237-9201 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-01-10 |