| NPI | 1265554935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD LEBARON Administrator 660-665-8491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center Public Health, State or Local |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2017-11-30 |