| NPI | 1912139841 |
|---|---|
| Doing Business As | EMERSON AVENUE DETNAL |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BACSA President 317-258-0309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 12010741a) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2009-08-11 |