| NPI | 1629399266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW J. MANDERY Physician 765-236-1290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IN 01045232) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2014-07-02 |