| NPI | 1427717644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY WEBER Chief Executive Officer 866-682-4842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2021-12-15 |