| NPI | 1801834221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY SELF Credentialing 423-442-2622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2024-07-12 |