| NPI | 1619667565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMI COTHARN Chief Operating Officer 409-938-2218 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2023-05-18 |