| NPI | 1891536561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN RENEE JOHNSON Asst. Dir. Of Patient Accounting 872-588-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-05 |