| NPI | 1295500429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA WARE CEO 580-925-3286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2024-03-01 |