| NPI | 1639483704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA FURNAE CAMPBELL JOHNSON Owner/Physician 317-257-1484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IN 01049424) |
| Enumeration Date | 2010-08-01 |
| Last Update Date | 2017-05-02 |