| NPI | 1497482822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH NIEBERGALL Credentialing Specialist 239-424-1446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-08-05 |