| NPI | 1851755466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHON AGEE Owner 317-300-0370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 71000676A) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2016-04-09 |