| NPI | 1770173908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KAY CLARK CEO 435-888-4411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2025-03-17 |