| NPI | 1629476890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WALLS Owner/Manager 765-352-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004944B) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2015-02-05 |