| NPI | 1932829280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY NICHOLS Executive Director 267-597-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-10-24 |