| NPI | 1124539648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONYA YORK Controller 870-856-1202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2023-10-31 |