| NPI | 1770282642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONDA ELLEN WALLACE CFO 937-324-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2024-11-20 |