NPI | 1700606340 |
---|---|
Entity Type | Organization |
Authorized Contact | TIMOTHY GRANT GILLUM Physician/Owner 765-651-4278 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
Enumeration Date | 2024-10-16 |
Last Update Date | 2024-12-03 |