| NPI | 1982079620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN PREAS President & Chief Executive Officer 800-492-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2024-11-18 |