| NPI | 1063099869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEREDITH WALL Revenue Cycle Manager 267-597-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2021-03-26 |