| NPI | 1083709521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WARREN Executive Director 251-690-8158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-04-29 |