| NPI | 1093029027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE GRAYER Lpn 409-779-9862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: AL 2-060494) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX 220648) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2010-08-02 |