| NPI | 1891983284 |
|---|---|
| Doing Business As | BALL STATE EMPLOYEE QUICKCLINIC, LLC |
| Entity Type | Organization |
| Authorized Contact | CHARLES R ROUTH Board Member 765-751-3152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2008-11-26 |