| NPI | 1164275491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY B DURALL Chief Financial Officer 270-338-5777 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-08 |