| NPI | 1952795957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY WARREN CEO 765-828-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-04-08 |