| NPI | 1376095083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT JOSEPH LOPEZ Chief Executive Officer 771-245-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2024-11-20 |