| NPI | 1699185769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATILDA A TENNESSEE Executive Director 504-658-2785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-07-21 |