| NPI | 1649692518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN MARIE POWELL CFO 317-225-1197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 08002748A) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-02-11 |