| NPI | 1164407763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLEY PAGE Director 417-861-9739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME81042) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2025-06-25 |