| NPI | 1700503745 |
|---|---|
| Other Name | 12TH STREET HEALTH AND WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | SUSAN D MOORE Manager 501-614-2006 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |