| NPI | 1801643200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL SPENCER CREITZ Cco 620-240-5015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-02 |