| NPI | 1902851082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN AYARS Chief Executive Officer 765-281-4257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-02-27 |