| NPI | 1558818666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERWANA LASTER Owner 317-441-1093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN 794) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |