NPI | 1922264597 |
---|---|
Entity Type | Organization |
Authorized Contact | TRENT L PHILLIPS Member/Owner 812-385-1200 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IN 08002386A) |
Enumeration Date | 2008-08-04 |
Last Update Date | 2008-08-04 |