| NPI | 1588667208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L WYNN Credentialing 417-823-2838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 118.6) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2025-08-15 |