| NPI | 1912022369 |
|---|---|
| Other Name | GOSHEN MEDICAL CENTER WALLACE |
| Entity Type | Organization |
| Authorized Contact | REBA W. FUTRELL Executive Assistant/Credentialing 910-267-8252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2012-02-06 |