| NPI | 1205678364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC ALLAN SHOEMAKER Md 260-423-2675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-10 |