| NPI | 1821428855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN STANTON Member 317-259-4616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QR0200X Clinic/Center, Radiology | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2014-02-27 |