| NPI | 1972301570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU LOPEZ Director Of Billing 800-492-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-08-11 |