| NPI | 1255771119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY CHEWNING Interim CEO 984-222-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-08-27 |