| NPI | 1700476306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D CROCKETT CFO 317-587-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2025-07-23 |