| NPI | 1790567766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE T RUCH CEO 567-661-0565 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-10-16 |