| NPI | 1982263752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET LYNN TIPTON Office Manager 680-688-2800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2023-12-14 |