| NPI | 1285579607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA HENRY CFO 870-508-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2026-04-22 |
| Last Update Date | 2026-04-22 |