| NPI | 1285193060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TILINA ROBINSON Credentialing 307-857-9486 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP0904X Clinic/Center, Public Health, Federal |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-05-03 |