| NPI | 1902930456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REX OWEN LEE President 660-665-5607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO r7689) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2010-06-17 |