| NPI | 1558017319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA CHARPENTIER Credentialing Specialist 401-780-2511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-03-01 |