| NPI | 1922071117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODY PALERMO CEO 907-733-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: AK 77895) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2014-07-25 |