| NPI | 1568169621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NYDIA NEAL Office Manager/Credentialing 386-837-7186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-09 |