| NPI | 1396986147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN RENEE JOHNSON Asst Dir Of Patient Accounting 872-588-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-03-07 |
| Last Update Date | 2021-07-01 |