| NPI | 1386326122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HAYDEN Credentialing Consultant 937-825-8631 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-02 |