| NPI | 1669697074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA CANNON CEO 641-446-2383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-02-11 |