| NPI | 1548528151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D MILLER Owner 317-773-1981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IN 18002264) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2021-10-25 |