| NPI | 1447994686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAFTA MCCAIN CFO 870-538-5414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-08-18 |