| NPI | 1528244613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABE MARTINEZ Manager 920-563-4372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2023-07-24 |