| NPI | 1992234660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE LATEK Executive Director 285-523-7718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2020-12-07 |