| NPI | 1922789163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI HARRIS Chief Financial Officer 315-425-1004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |