| NPI | 1548467640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES PUCKA Owner 765-446-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IN 08001350) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2009-06-04 |