| NPI | 1629119177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MICHELLE JOHNSON Sole Employee 812-522-9761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 01054624A) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-08-22 |