| NPI | 1053879619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN L STEVENS Executive VP 660-890-1690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2020-09-15 |