| NPI | 1881888329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TESS LYNNE BIRD Office Manager 660-263-3185 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R7880) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2012-02-07 |