| NPI | 1245957208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC E LOY C30 270-858-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |