| NPI | 1407527203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN STANLEY Nurse Practitioner 660-723-0953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-10-25 |