| NPI | 1114515392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLE STARK Credentialing Officer 660-424-0794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2024-09-26 |