| NPI | 1740945534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLEY PAGE Director 417-861-9739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2025-06-25 |