| NPI | 1427694314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KELLER Medical Director 765-973-9294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2022-09-07 |