| 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 | 2025-09-08 |