| NPI | 1497302723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ALLEN SWAB CFO 270-338-5777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2019-12-17 |