| NPI | 1104690627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE STATES Director Of Operations/Compliance 330-564-8681 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-11-15 |