| NPI | 1801171004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF W SELBY Mbr 812-853-5864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01027862A) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2011-12-07 |