| NPI | 1578194049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RIGGS CFO 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2020-02-03 |