| NPI | 1548017601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONYA YORK Controller 870-856-1202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-12-04 |