| NPI | 1184192064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA SABELLA CEO 979-383-2348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2024-07-10 |