| NPI | 1174215446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED POLLICK Executive Director 937-548-3806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-05-24 |