| NPI | 1114066297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT A. KEANE Chief Executive Officer 202-715-6562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QM0801X | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-05-13 |