| NPI | 1629083019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL PLANO CFO 812-699-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2017-10-26 |