| NPI | 1275175002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI BARNES Provider Enrollment 563-336-3225 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |