| NPI | 1528539590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY GATES Revenue Cycle Manager 765-254-2685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2018-12-17 |