| NPI | 1932188331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ALFRED FRETZIN Member 317-516-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-04-12 |