| NPI | 1568654432 |
|---|---|
| Doing Business As | PROVIDENCE ELEMENTARY HEALTH CLINIC |
| Entity Type | Organization |
| Authorized Contact | ANGEL THOMPSON Administrative Service Manager 270-686-7747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2008-12-23 |