| NPI | 1033895628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA PRUITT Billing Coordinator 573-332-0808 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-06-27 |