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 |