| NPI | 1639358641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KEVIN STINE Owner/Physician 317-610-3003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01030274A) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2010-03-16 |