| NPI | 1881923126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RORY MATHISEN Director Of Operations 251-751-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251V00000X Voluntary or Charitable (Licence: GA 054389) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2022-09-23 |