| NPI | 1992473334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA L PORTER Credentialing & Contracting Manager 660-890-8156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2021-09-01 |