| NPI | 1407989510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA M LALOR Director / Delegated Official 629-215-3953 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2021-04-16 |