| NPI | 1003827650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES FEESE Executive Director 573-860-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NM CL00010409) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-11-19 |