| NPI | 1699920272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA ROBERTS Manager 812-949-3482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: IN 01033436A) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2009-02-24 |