| NPI | 1467336354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMAN N. KING CEO 260-266-0780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |