| NPI | 1902067598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERYL LYNN RANDOLPH Owner 260-338-2048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IN 01055463) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-06-17 |