| NPI | 1902237035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CALLAHAN Np 484-351-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 2013040389) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: MO 2013040389) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2013-11-27 |