| NPI | 1457696189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL PLANO CFO 812-699-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2017-10-26 |