| NPI | 1568189488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC E LOY C3 O 270-858-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |