| NPI | 1417063470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLENE MANGAHAS President 219-397-6903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01045012A) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |