| NPI | 1467072330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY UGRIN CEO 606-796-3029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |