| NPI | 1790742971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALI MANSOUR EBRAHIMI President 660-826-0027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 101862) |
| Enumeration Date | 2006-04-30 |
| Last Update Date | 2020-08-22 |