| NPI | 1790787919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMIQUA BAKER Senior Project Manager 716-986-9199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 1401230R) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2025-10-01 |