| NPI | 1588347546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN NICHOLE KING CEO 260-266-0787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2023-08-08 |