| NPI | 1033677307 |
|---|---|
| Doing Business As | 11TH AVENUE FAMILY MEDICINE CLINIC |
| Entity Type | Organization |
| Authorized Contact | SHANNON FERNANDEZ VP Of Billing 508-865-6175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2022-11-01 |