| NPI | 1619708898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY NICHOLS Executive Director 267-597-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-11-15 |