| NPI | 1770983199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN STANTON Member 317-730-0525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| 261QR0200X Clinic/Center Radiology | |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2015-02-18 |