| 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 |