| NPI | 1982267910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY WELLS Credentialing Officer 580-387-0509 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-08-21 |