| NPI | 1417661893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTLE CAMERON Credentialing Administrator 239-344-2391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2023-01-10 |