| NPI | 1487430864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CHRISTENSON Executive Director 765-780-7689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-11-05 |