| NPI | 1255572475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENELLA M WASHINGTON CEO 199-250-2923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2023-07-10 |