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 |