| NPI | 1326608001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI SOULE CEO 772-257-8224 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2022-03-22 |