| NPI | 1619307022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE ENDRESS Credentialing Specialist 716-348-3000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2021-09-09 |