| NPI | 1649469644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JAMES TEAFORD Administrator 660-747-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2013-08-29 |