| NPI | 1942367370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LYNN NETTLES Billing Manager 523-638-4997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2025-08-11 |