| NPI | 1841856556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BLAINE CEO 599-258-8005 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2024-07-10 |