| NPI | 1962591537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN MICHELLE JOHNSON Owner 219-661-3013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: IN 71000253A) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |