| NPI | 1285185587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE KNORR Sr. Contracting & Credentialing Spe 605-789-6695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 305S00000X Point of Service (Licence: KY 3010757) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2022-06-27 |