| NPI | 1720347305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK W SHAFER C.F.O. 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2016-07-20 |