NPI | 1184710428 |
---|---|
Doing Business As | FORTSON FAMILY CARE AND WELLNESS CENTER |
Entity Type | Organization |
Authorized Contact | DARRYL L FORTSON President & CEO 219-924-9277 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01037803) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2007-12-03 |