| NPI | 1083381974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA COLLIER Credentialing And Contracts Admin 386-202-6025 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-27 |