| NPI | 1518710680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS L. GILLIOM CEO 765-446-6540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2024-04-09 |