| NPI | 1245051895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM M MOORE Executive Director Of Practice 660-626-2739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-23 |