| NPI | 1073222402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID EDWARD BRAZIL CEO 620-221-3350 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2022-11-15 |