| NPI | 1912458613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI SOULE CEO 772-257-8224 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2022-03-22 |