| NPI | 1053787721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDETTE G HUMPHREY CEO 207-528-2285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2024-09-17 |