| NPI | 1164264834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELYSE KNOBLOCH Chief Financial Officer 870-538-3355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-06-12 |