| NPI | 1376962480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER W CHALFANT Owner 260-925-0357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: IN 08001701A) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-23 |