| NPI | 1780441709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELYSE KNOBLOCH CFO 870-538-5414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-03-05 |