| NPI | 1922671312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM L DALTON CEO 317-856-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2025-11-11 |