| 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 |