| NPI | 1811551211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESLEEN E FULTZ CEO 574-970-3257 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |