| NPI | 1306377072 |
|---|---|
| Doing Business As | FORT LOGAN HEALTHY KIDS CLINIC |
| Entity Type | Organization |
| Authorized Contact | ERIC E LOY CEO 270-864-1472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: KY 700172) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |