Graduated: 2014
NPI: 1649737107
Practice Locations (6)
3512 STELLHORN RD
FORT WAYNE, IN 468154631
100 N TILLOTSON AVE
Muncie, IN 473043987
240 N TILLOTSON AVE
MUNCIE, IN 473043988
PO BOX
CINCINNATI, OH 45263
PO BOX, SUITE 1059
LYMAN, SC 29365
3824 CEDAR SPRINGS RD, SUITE 8015343
DALLAS, TX 752194136
Source: CMS National Downloadable File, September 2026.