Provider Type: Ambulatory Health Care Facilities
Provider Classification: Clinic/Center
Provider Specialization: Federally Qualified Health Center (FQHC)
Address: 2050
BZFglDnVHhRqAQtmY
4400, AR 55280
Authorized Official: 85601 16257, 213183 31003, 24429, 87337
Authorized Official Position: 2164