| NPI | 1700811635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSH GOSSAGE Management Analyst 564-397-8102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center Public Health, State or Local |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261Q00000X Clinic/Center | |
| 261QC1500X Clinic/Center Community Health | |
| 261QD0000X Clinic/Center Dental | |
| 261QF0050X Clinic/Center Family Planning, Non-Surgical | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-11-24 |