| NPI | 1972129112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU LOPEZ Director Of Central Operations 800-492-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |