| NPI | 1861034688 |
|---|---|
| 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 | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |