| NPI | 1124319942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KECIA FULCHER CEO/Director 270-886-2205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2018-03-16 |