| NPI | 1699335042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRESTON PEACHEE Tin Owner 317-653-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2020-04-22 |