| NPI | 1760679401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW THERIAC Doctor/Owner 660-385-3623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MO 15187) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2007-09-26 |