| NPI | 1104690627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FRISONE Executive Director 888-975-9188 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2025-03-21 |