Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2012-04-13
- Last updated
- 2012-04-13
Specialties
Licenses
- License IN
- 01028579A
Location
- Practice location
- 350 JH WALKER DR, SUITE 110
- City
- PENDLETON IN
- Postal code
- 460648750
- Phone
- 765-622-0003
Organization contact
- Name
- DENNIS FAST
- Title
- President
- Phone
- 7656220003
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.