| NPI | 1992416259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JOSEPH WILTRAUT CEO 972-682-8917 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-07 |