| NPI | 1407519218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC E LOY CEO 270-858-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-10-19 |