| NPI | 1770635633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY GERVIE Controller 256-640-9674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-03-26 |