| NPI | 1528875358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN KING CEO 260-266-0780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-16 |