NPI | 1104133511 |
---|---|
Entity Type | Organization |
Authorized Contact | BRYAN AYARS Chief Executive Officer 765-747-2971 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2010-09-07 |
Last Update Date | 2020-11-30 |