| NPI | 1528466091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA J BOWMAR Admin 219-221-7287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IN 01020627A) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2014-12-15 |