| NPI | 1215744693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SULLIVAN CFO 959-216-7305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |