NPI | 1053458380 |
---|---|
Entity Type | Organization |
Authorized Contact | MERRILL THOMAS MILLER Owner 573-888-5896 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO T02701) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2020-08-22 |