| NPI | 1750113452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRI LYNN GEHLHAUSEN Director 765-564-3016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |