| NPI | 1538974910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANA BEAL Doc 541-851-8110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-11 |