| NPI | 1376907493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY BURKE Chief Executive Officer 000-000-0000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2021-05-27 |