| NPI | 1952792517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEOFFREY AARON MCCORD Owner/Member LLC 260-333-2274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71003735A) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-04-01 |