| NPI | 1861468340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY HEINZEN Executive Director 731-659-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2025-04-23 |