| NPI | 1902827512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA L. BAIR Brenda Bair, Business Manager 660-886-3364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2014-05-29 |