| NPI | 1821390709 |
|---|---|
| Doing Business As | INTERNATIONAL COMMUNITY CLINIC |
| Entity Type | Organization |
| Authorized Contact | EROMONSELE O. IDAHOSA Medical Director 317-602-3558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: IN 01057350A) |
| Enumeration Date | 2010-11-25 |
| Last Update Date | 2010-11-25 |