| NPI | 1952892770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL SMITH Practice Manager 765-939-2037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01045404) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |