| NPI | 1780071118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA D MASON Owner 765-362-3579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 71002953A) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-06-04 |