| NPI | 1255179644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA BRIGHTLEY Lead Credentialing Specialist 270-297-6758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-07-18 |