| NPI | 1326458928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK SHAFER CFO 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2016-09-15 |