| NPI | 1245289214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JOHNSON Asst Dir Of Patient Accounting 872-588-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-06-24 |