| NPI | 1962435933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M JONES CEO 774-627-1205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MA 4131) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2025-08-15 |