| NPI | 1043707896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GEE Executive Director 731-644-8479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |