| NPI | 1215110200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEOFILO BAUTISTA President 219-938-4481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01032450A) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |