| NPI | 1912696923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONYA YORK Controller 870-856-1202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2024-03-26 |