| NPI | 1891227179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA M SPENCER Chief Executive Officer 386-328-0108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2020-02-13 |