| NPI | 1457049439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERA GREEN Credentialing Manager 267-264-4669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2026-04-15 |