| NPI | 1184102881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNEX LUBERISSE Director Of Operations 660-229-0858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2023-09-06 |